U.S. researchers in Africa
said that they found that
circumcision is such a good
defense against
HIV
infection that they shut down
two studies early, and instead
offered all participants a
chance to be circumcised.
One study in the east African
country of Kenya showed that
circumcision cut adult males'
HIV infection risk from heterosexual
intercourse by 53 percent,
while another study in Uganda
lowered the risk by 48 percent,
according to results released.
The findings, financed by
the U.S.
National Institutes of Health
(NIH), pointed out that the
latest conclusions confirmed
previous investigations into
the value of circumcision
as a protection against HIV,
the virus that causes
AIDS.
This is especially important
in Africa, where AIDS is an
epidemic in many countries,
infecting an estimated 25
million people on the continent.
Despite the good news, there
is still plenty of reason
for caution, AIDS experts
said.
"Male circumcision is a difficult
intervention to implement,
and the preventive effect
is relative, not absolute,"
said Thomas Coates, an AIDS
specialist and a professor
of medicine at the University
of California at Los Angeles.
"The magnitude of effect is
50 to 60 percent, which still
leaves ample room for people
to get infected with HIV."
There are other caveats as
well: The study did not look
at male-to-female transmission,
and it was also not clear
whether circumcision makes
it less likely that gay men
could transmit HIV to each
other.
In the United States, homosexual
transmission of HIV is more
common than heterosexual transmission,
the experts said. And most
men in the United States are
circumcised, making the procedure
less effective as a possible
prevention tool.
Still, the findings could
have plenty of meaning in
Africa, where HIV is commonly
spread between men and women.
Studies have suggested the
value of circumcision in the
past, but researchers wanted
to confirm the previous findings.
According to the NIH, most
adult Africans are circumcised,
but the rate drops below 20
percent in some areas of southern
Africa where HIV and AIDS
are common.
In one of the two studies,
researchers enrolled 2,784
HIV-negative, uncircumcised
men in Kenya beginning in
2002. The other study, in
Uganda, started in 2003 and
enrolled 4,996 HIV-negative,
uncircumcised men.
Some of the men were assigned
to immediately undergo circumcision,
while others had to wait two
years.
Then researchers studied
whether the circumcision had
any effect on their rates
of getting HIV.
The results were so encouraging
that an oversight board halted
the studies this week, and
ordered that all participants
be given circumcisions instead
of having to wait.
In Kenya, researchers found
that only 22 of the 1,393
circumcised men in the study
were infected with HIV, compared
to 47 of the 1,391 men who
had yet to be circumcised.
The numbers for Uganda weren't
immediately available.
"Circumcision is now a proven,
effective prevention strategy
to reduce HIV infections in
men," Robert Bailey, a study
investigator and professor
of epidemiology at the University
of Illinois at Chicago, said
in a statement.
It's not entirely clear how
circumcision reduces HIV infection.
But researchers have suggested
that the foreskin may provide
a moist, safe environment
for the AIDS virus and provide
more immune cells for HIV
to infect.
Coates called the study
results the "second greatest
finding in HIV prevention,"
right behind research that
confirmed drugs could stop
mother-to-baby transmission
of the AIDS virus.
Still, he added, "combination
prevention" remains crucial
-- combining circumcision
with using condoms, reducing
sexual partners, and delaying
the first time people have
intercourse.
The Associated Press
reported that the link between
male circumcision and HIV
prevention was first noted
in the late 1980s. The first
major clinical trial, of 3,000
men in South Africa, found
last year that circumcision
cut the HIV risk by 60 percent.